No one expects an app to take the place of an actual doctor’s visit, but could we design one that asked some of the same questions a doctor would, and then guide a user down a diagnostic and treatment path? There are already many websites that provide similar services to the casual web surfer, so a mobile app that interacts with a user not just to give kudos and badges, but to lead to potential diagnoses, provide current educational information, and suggest possible treatments would not seem far-fetched. MobileSleepDoc V1.0 was problem-centric, as is the case with most medical apps my colleagues and I use on a daily basis. MobileSleepDoc V2.0, on the other hand, is user-centric, whereby the user’s personal sleep profile and sleep reports are presented to the user when they log into the app.

Working on the MobileSleepDoc mobile app for the past 2 years, I have become acquainted with a brand new jargon. Words and phrases like “pivot” and “user friction” are old concepts with a fresh twist. I especially like the concept of pivoting, which amounts to making rapid changes in response to and/or anticipation of a change in business model. After releasing version 1.0 of the app, we had no idea how many pivots we would be making between versions 1.0 and 2.0. The changes were all precipitated by key events. I share these so that others may benefit from what we’ve learned in a whirlwind year.

Shortly after releasing version 1.0, I spoke in-depth with an app marketing company, and was advised to run a focus group–and this would be Event #1–Run a Focus Group. The 12-person group was assembled, and the users played with the app for a few weeks and answered many questions. The end result, 2 months later, was an extremely useful, comprehensive report that would change the course of the app and our business for good. The key question at the end of the group, “Would you recommend this app to a friend?” gave us some “maybe’s” that we would have to learn how to turn into “yes’s.”

Event #2—Create a Business Model. Some people advise creating a business plan before starting a business, but I’m not sure I knew I was creating a business when we developed MobileSleepDoc V1.0. My goal simply was to help as many people with sleep problems as possible for the lowest possible cost, but after that, things were fuzzy. After advice from a few friends, I hired a consultant, an MBA-type, to come pick my brain and point out to me things I didn’t know I knew. After several meetings, the result was a comprehensive report describing our business model and projected financials. These documents serve as a dynamic, working framework of the app and where it may lead.

Event #3—Hire a New Development Team. After 12 months and many late nights working together, the original app developers and I established a productive working relationship. I became very fond of them as individuals and co-collaborators. But what I learned from our focus group was that we needed a strong DESIGN team that understood how to optimize the user’s experience. We then realized we needed to let the old development team go and replace it with a new one whose main strength was in the areas where the previous team fell short. This was an expensive and difficult decision, and it meant losing momentum to teach a brand new team the logic of the app. In the end, we successfully revamped MobileSleepDoc Pro in version 2.0, and launched it in the Apple app store in October 2014.

The major changes include:
1. The new app is User-centric instead of Problem-centric, and centers around the user’s “My Sleep Profile” page.
2. A brand new logo and modern graphics throughout, including extensive sleep reports.
3. A Rewards Program to game-i-fy the most important (and HARDEST) aspect to getting a good night’s sleep—changing the user’s behavior.
4. Animal Dream Totems to place on the user’s Virtual Night Stand. The totems borrow from the Native American tradition of animal spirits carrying potential messages to the user.
5. Brand new soundscapes recorded exclusively for MobileSleepDoc.
6. The User may log sleep manually or sync with their Fitbit!

For many years, doctors have been recommending collecting data from patients at home, whether for monitoring blood sugars, blood pressure, peak flows (rate of respiratory volume exhaled), or heart rhythms. In sleep medicine, we often ask patients to keep sleep logs, which is a simple and informative way to graph sleep/wake behavior. Sleep logs are especially useful in patients with insomnia and sleep schedule irregularity (e.g. circadian rhythm disorders). Sleep log data are further supported (or disputed) by the passive monitoring of user behavior through the use of wrist actigraphy, a tiny computer worn on the wrist over several days (photo above, top). Wrist actigraphy is a well-established research tool but not commonly done in the office setting, perhaps because it is not reimbursed by most insurance companies. It is a test I have found to be universally useful in my practice. After wearing the wrist actigraph for 5-7 days, the patient brings it back to the office and we download the data, which shows quite sensitively, their pattern of activity versus stillness, the latter correlating with time asleep. From the data we can tell whether or not they go to bed around the same time each night, keep a regular wake-up time, how long they slept, and how many (and how long) awakenings (active periods at night) they experienced each night.

With the advent of fitness and sleep trackers like the FitbitTM (photo above, bottom), I now find myself analyzing the same data and reports on a patient’s smartphone through associated apps. In fact, I often recommend the use of fitness trackers to my patients to encourage regular physical activity AND to monitor their sleep routines, since both of these “interventions” improve sleep quality. These ubiquitous, electronic “flies on the wall” of a patient’s real life are not prescribed as medical devices, but rather are lifestyle-biofeedback-awareness tools at an affordable price. But can they provide clinical benefit to a person? Absolutely. The biggest challenge, however, may be helping the user make sense of the data they are collecting. That’s where working with a provider may be truly enlightening and beneficial to someone’s health. One additional benefit? I am no longer in charge of keeping the patient/user data, but the individual is, and that is one of the biggest advantages of getting tracking devices into the hands of more people. Getting people involved in their health makes them healthier.

I’ve read your blog with great interest, especially your work in designing a mobile app. I work with the California Thoracic Society (largest chapter of ATS) and we are in the process of expanding our patient outreach efforts. Would it be possible for you to contact me by email?